Expanding pharmacist prescriber authority for HIV PrEP medications significantly increased PrEP use.
States that allow pharmacists to prescribe and dispense medications have significantly higher prescriptions for HIV PrEP (pre-exposure prophylaxis), according to a new report from GoodRx Research. In fact, PrEP fills grew 24% after one year and 110% after two years in states that passed pharmacist prescriber policies for PrEP.
According to previous research, only 25% of those eligible for PrEP actually receive it. PrEP reduces the risk of getting HIV from sex by about 99%, according to the CDC. Two medications have been approved: Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide), both of which have been developed by Gilead.
“This research suggests that, if given the prescribing power, pharmacists could play a major role in improving access to essential medication. This is especially important in areas that lack adequate healthcare services,” Tori Marsh, MPH, director of Research at GoodRx, told Formulary Watch.
Patients see their pharmacist nearly 12 times more frequently than their healthcare providers. “This visibility makes pharmacies a powerful touchpoint for care and creates an enormous opportunity to bridge current gaps in the healthcare system,” Marsh said.
GoodRx Research examined the annual fill rate index from 2014 to 2022 for PrEP. They wanted to know if increasing pharmacist prescribing power would improve patient accessibility.
A few states currently allow pharmacists to prescribe other medications, including birth control, smoking cessation medications, and medications for conditions such as asthma and diabetes. Several U.S. states have passed policies allowing pharmacists to prescribe and dispense medications. And some states beginning in 2020 — California, Colorado, Oregon, Nevada, Washington, Maine, Virginia, New Mexico — passed legislation that allows pharmacists to initiate PrEP.
GoodRx researchers found that PrEP fills remained relatively flat in states that didn’t pass policies expanding pharmacist authority.
Giving pharmacists the power to initiate prescriptions could affect health equity, GoodRx suggests. Researchers looked at under-resourced areas that could potentially benefit from expanded pharmacist prescriber authority. They found that 20% of U.S. counties stand to gain from pharmacist prescriber authority. These counties contain more than 37 million people. Many counties in the South, Southeast, and Midwest have adequate pharmacy access but inadequate access to primary care or health clinics.
GoodRx also said there are implications beyond PrEP. “This research suggests that pharmacy prescriber power can aid in improving access to preventive medications, and considering how often patients see their pharmacists, it’s likely that this finding can be extrapolated to many other medications,” Marsh said.
Pharmacists’ ability to prescribe is expanding. Most recently, in July 2022, the FDA authorized all state-licensed pharmacists to prescribe Pfizer’s Paxlovid (nirmatrelvir/ritonavir), an antiviral used for the treatment of COVID-19. Pharmacists are required to confirm that Paxlovid is being prescribed for eligible patients and refer patients to a physician or nurse practitioner. “Since Paxlovid must be taken within five days after symptoms begin, authorizing state-licensed pharmacists to prescribe Paxlovid could expand access to timely treatment for some patients who are eligible to receive this drug for the treatment of COVID-19,” Patrizia Cavazzoni, M.D., director for the FDA’s Center for Drug Evaluation and Research, said in a press release at the time.
GoodRx includes a table of states with expanded pharmacist prescribing authority here.